Provider Demographics
NPI:1710016829
Name:COUNTY OF MENDOCINO
Entity Type:Organization
Organization Name:COUNTY OF MENDOCINO
Other - Org Name:NEW BEGINNINGS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:PINIZOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:707-472-2300
Mailing Address - Street 1:1120 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-472-2300
Mailing Address - Fax:
Practice Address - Street 1:518 LOW GAP RD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3735
Practice Address - Country:US
Practice Address - Phone:707-472-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MENDOCINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABBB33295BOtherMH SUBMITTER #
CA00023Medicaid
CA2351Medicaid
CA2351Medicaid
CA156456Medicare ID - Type UnspecifiedMH MEDICARE RECEIVER